Neonatal mortality due to preterm birth at 28-36 weeks' gestation in China, 2003-2008

Almost all (99%) neonatal deaths occur in developing countries, where the progress in reducing neonatal mortality rates (NMR) has been small; the Millennium Development Goal for child survival cannot be met if this situation continues. China is among the 10 countries that have the largest numbers of neonatal deaths. In order to provide effective interventions to reduce the national NMR for government policy makers, we analyse the trends, causes and characteristics of the neonatal deaths of preterm babies in different regions of China during the period 2003-2008. The data for this retrospective study were retrieved from the population-based Maternal and Child Health Surveillance System of China. The Cochran-Armitage trend test was used to analyse the trend of NMRs due to immaturity. The national NMR due to immaturity has decreased by 38.7% in 6 years. However, the proportion of preterm births among the causes of neonatal death has increased significantly from 33.6% in 2003 to 40.9% in 2008. The relative risk of neonatal death among preterm babies has shown significant regional disparity. In 2008, the adjusted relative risk was 1.30 [95% confidence interval (CI) 0.95, 1.78] in the inland regions and 2.37 [95% CI 1.56, 3.60] in the remote regions, both compared with the coastal regions. The proportion of neonatal deaths with a gestational age <32 weeks or a birthweight <1500 g was highest among the coastal regions. Most neonatal deaths of preterm babies in remote areas were born at home and were not treated before death. Our study suggests that preterm birth is the leading cause of neonatal death in China and neonatal mortality due to immaturity displayed regional differences. The Chinese government should implement major effective strategies for reducing the mortality of preterm infants to further decrease the total NMR. Priority interventions should be region-specific, depending on the availability of economic and health care resources.     

Parametric modelling of neonatal mortality in relation to size at birth

We use a richly parameterized model to analyse the effects of shortness and thinness at birth on neonatal mortality in Swedish live-born singletons. The model captures the hazard of neonatal mortality according to the function alpha x exp(-gamma x t) + delta, where t represents age. Covariates are allowed to simultaneously influence the initial excess hazard, the rate of decay, and the long-term hazard. Among term newborns, birth length for gestational age had a stronger effect on the long-term hazard and a weaker effect on the initial excess hazard than the Ponderal index. The initial excess hazard associated with a low Ponderal index tended to decay quickly. Among preterm newborns, a higher birth length for gestational age was associated with lower initial and long-term hazards, and with a faster rate of decay of the initial excess hazard. In contrast, the Ponderal index was not associated with the long-term hazard. We discuss the interpretability of the model and its potential use in neonatology and medical demography. We also compare the model to a Cox model with time-dependent covariates.     

Path analysis on the risk of mortality in very low birth weight infants

Objective: The purpose of this work is to clarify by path analysis which of the predictor factors of mortality in a cohort of 423 singletons VLBW infants born at Beilinson Medical Center during the years 1980–1990 (pre-surfactant era) exert direct or indirect effect on mortality. A direct risk factor was defined as a factor having an immediate effect on the outcome without working through an intermediate variable. By contrast, an indirect risk factor was defined as a factor that does not have a direct effect on the risk of mortality but instead works through an intermediate variable. Evaluation of mortality was done at three points over time (pre-delivery, at birth and post-delivery). Results: In the pre-delivery model, gestational age, appropriateness for gestational age, mother's age and fetal distress work directly on mortality in VLBW infants. At birth, mother's age, birth weight and Apgar score at the fifth minute work directly on the risk of mortality. When the assessment of the risk of death was done post-delivery, mother's age, birth weight, Apgar score at the fifth minute and seizures influence directly on mortality risk, and fetal distress, gestational age and pre-natal induced hypertension (PIH) operate indirectly on the risk of mortality. Conclusion: The methodology we have used can be adopted in other investigations to distinguish and measure the effect of prognostic factors on the risk of an outcome.     

Weight at birth and all-cause mortality in adulthood

BACKGROUND: Small size at birth is associated with subsequent cardiovascular disease and diabetes, and large size is associated with obesity and cancer. The overall impact of these opposing effects on mortality throughout the lifespan is unclear because causes of death change with age. METHODS: We investigated the association of birth weight with adult all-cause mortality using a Danish school-based cohort of 216,464 men and women born from 1936 through 1979. The cohort was linked to vital statistic registers. The main outcome was all-cause mortality from ages 25 through 68 years. Associations with death from cancer, circulatory disease, and all other causes were also examined. RESULTS: During 5,205,477 person-years of follow-up, 11,149 deaths occurred among men and 6609 among women. The cumulative hazard ratios of the association between birth weight categories and all-cause mortality was constant for all ages investigated and did not differ between men and women. Compared with subjects having birth weights in the reference category (3251-3750 g), those with the lowest birth weights (2000-2750 g) had 17% higher mortality (95% confidence interval = 1.11-1.22), and those with the highest birth weights (4251-5500 g) had 7% higher mortality (1.01-1.15) from all causes. The association of birth weight with cancer increased linearly, whereas the association of birth weight with circulatory disease and all other causes was U-shaped. CONCLUSIONS: To the degree that the association of birth weight with adult survival is causal, the U-shaped association between birth weight and adult mortality suggests that population increases in birth weight may not necessarily lead to improved health in adulthood.     

Body composition in human infants at birth and postnatally

The predictive values of anthropometric measurements, race, gender, gestational and postnatal ages, and season at birth and at study for the total body dual energy X-ray absorptiometry (DXA)-derived lean mass (LM), fat mass (FM) and fat mass as a percentage of body weight (%FM) were determined in 214 singleton appropriate birth weight for gestational age infants [101 Caucasian (60 boys, 41 girls) and 113 African American (55 boys, 58 girls)]. Gestational ages were 27-42 wk and the infants were studied between birth and 391 d, weighing between 851 and 13446 g. In addition, predictive value of body weight, LM and FM for DXA bone measurements was also determined. Scan acquisition used Hologic QDR 1000/W densitometer and infant platform and scans without significant movement artifacts were analyzed using software 5.64p. Body weight, length, gender and postnatal age were significant predictors of LM (adjusted R:(2) >0. 94) and FM (adjusted R:(2) >0.85). Physiologic variables had little predictive value for %FM except in the newborns (adjusted R:(2) 0. 69). Body weight was the dominant predictor of LM and FM, although length had similar predictive value for LM with increasing postnatal age. Female infants had less LM and more FM throughout infancy (P: < 0.01). LM or FM offered no advantage over body weight in the prediction of bone mass measurements. DXA is a useful means with which to determine body composition, and our data are important in the design and assessment of nutritional intervention studies.     

家庭阶段性综合保健指导在极低出生体重儿中的应用

目的探讨家庭阶段性综合保健指导在极低出生体重儿中的应用。方法 15例极低出生体重儿早产儿,出生病情稳定后即开始接受早期综合干预指导,早期干预分5个阶段,专人负责,以鲍秀兰教授等编制的光盘、书籍:《婴儿科学健身法》、《塑造最佳人生开端》、《0～2岁运动落后的家庭指导》为教材,对VLBW儿童在动作、语言、认知能力及个人-社会交往4个方面进行训练指导,同时重视VLBW的体格发育及疾病预防。干预措施主要通过家长在家庭中实施,每月进行发育评估。结果 15例均完成18月龄的全程监测,12例完成CDCC测查,其中1例MDI﹤69,14例MDI在71～112分之间;PDI在正常范围内,无脑瘫。结论家庭阶段性综合保健干预指导强调以家庭康复为核心,重视基础保健和神经康复并重,可促进极低出生体重儿中智能发育。     

足月儿出生时脐血凝血状态的研究

目的 探讨正常足月儿出生时脐带血的凝血功能,评价各项指标的波动范围,为临床评估足月儿凝血功能提供参考范围,给干预治疗提供依据.方法 2014年1月至2015年12月前瞻性调查52对母儿,根据影响因素分为高龄产妇组、适龄产妇组,围生期感染组、非感染组,妊娠合并症组、健康孕妇组,再分别进行比较,通过非肝素化的脐带静脉及动脉标本,检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT).结果 足月儿脐动脉血各凝血指标PT、APTT、FIB、TT值分别为11.5~17.4s、45.2~93.6s、0.8~2.1g/L、18.6~28.3s,脐静脉血分别为11.0~15.3s、46.2~81.9s、0.9~2.0g/L、19.1~27.4s,比较差异均无统计学意义,t值分别为1.605、0.366、1.399、0.150,均P>0.05;足月儿脐静脉血PT、APTT、TT明显高于产妇静脉血,FIB低于产妇静脉血,差异均有统计学意义,t值分别为16.060、16.588、3.601、24.234,均P<0.05;PT在围产期感染组为11.3±1.7s,短于非感染组,差异有统计学意义(t=3.071,P<0.05);FIB在妊娠合并症组为1.0±0.2g/L,低于健康孕妇组,差异有统计学意义(t=3.123,P<0.05);早产儿PT、APTT、TT明显高于足月儿,FIB低于足月儿,差异均有统计学意义,t值分别为5.616、7.375、2.227、2.541,均P<0.05.结论 足月新生儿出生时脐动静脉血凝血指标无明显差别,PT、APTT、TT值较早产儿低,脐静脉血PT、APTT、TT明显高于产妇静脉血各指标,围生期感染时脐血PT缩短,妊娠合并疾病时脐血FIB降低,这些指标的初步研究结果,可为临床研究和应用提供参考,值得进一步研究.     

Variations in perinatal mortality according to the hour of birth in Switzerland

Summary In Switzerland like in most developed countries, the number of births is strongly related to the hour of the day and the day of the week: this pattern is very probably related to the current practice in obstetrics. Less expected is the fact that the perinatal mortality shows a striking circardian rythm according to the hour of birth. The paper presents this pattern and comments some related issues.

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Périnatale Mortalität nach Geburtsstunden in der Schweiz

Zusammenfassung In der Schweiz, wie in den meisten industrialisierten Ländern, besteht ein Zusammenhang zwischen der Zahl der Geburten und der Tageszeit sowie dem Wochentag. Wahrscheinlich hängt dies mit den üblichen Vorgehensweisen der Geburtshilfe zusammen. Gleichzeitig wurde ein erstaunlicher 24-Stunden-Rhythmus der perinatalen Mortalitätsrate im Vergleich zur Stunde der Geburt festgestellt. Diese unerwarteten Schwankungen sollten in epidemiologischen Studien im Hinblick auf ihre Ursachen untersucht werden.

     

维生素D水平与极低出生体重儿临床结局的相关性研究

目的分析出生时血清25-羟维生素D[25-(OH)D]水平对极低出生体重儿临床结局的影响,为早产儿相关疾病的预防和治疗提供新的方向。方法选取2019年9月-2020年9月在济宁医学院附属医院NICU住院治疗的105例极低出生体重儿为研究对象,根据出生24 h内血清25-(OH)D水平,将患儿分为维生素D严重缺乏组(A组)、维生素D缺乏组(B组)及维生素D正常组(对照组),对三组母婴一般资料、住院期间的治疗情况、合并症及临床转归进行比较。结果所有患儿出生时血清25-(OH)D平均值为(14.33±3.60)ng/ml,维生素D缺乏的发生率为79.1%。夏秋季节出生的患儿血清25-(OH)D明显高于冬春季节(t=2.71,P=0.01)。A组、B组患儿的出生体重、出生体重Z评分及1 min Apgar评分均较对照组低(F=0.86、 5.43、9.05,P<0.01)。母亲年龄越大,维生素D水平越低,差异有统计学意义(F=8.40,P<0.01)。A组、B组患儿住院时间、用氧时间、机械通气时间、无创通气时间均高于对照组,差异有统计学意义(F=19.65、7.45、15.97、4...     

Adding years to life: effect of avoidable mortality on life expectancy at birth.

STUDY OBJECTIVE--The aim was to determine the number of years that could be gained by preventing avoidable deaths. DESIGN--The study arose from the concept of avoidable causes of death and life expectancy at birth. Four abbreviated life tables were computed. The first included all causes of death; the second excluded all avoidable causes of death; the third and fourth excluded respectively primary and secondary avoidable causes of death. SETTING--Mortality and population data were taken from Mortality Statistics Offices in Valencia Region, Spain. MAIN RESULTS--Life expectancy at birth (LEB) was 75.7 years. After removing all avoidable deaths, LEB increased by 1.74 years. This improvement is attributed to avoidable deaths by primary prevention (1.09 years) and avoidable death by secondary prevention (0.37 year). CONCLUSIONS--According to these results the greatest improvement in LEB would be gained by primary prevention.     

Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women

Health characteristics of neonates born to human immunodeficiency virus (HIV) seropositive (n = 63) and HIV seronegative (n = 57) women were compared. No significant differences were found between the two infant groups for sociodemographic characteristics, mode of delivery, Apgar scores, gestational age, growth parameters, or immunoglobulin levels. Furthermore, no differences were detected in a subgroup of infants later confirmed to have HIV infection (class P-2). Maternal HIV infection does not appear to affect newborn health characteristics.     

产前诊断对9339例围生儿出生缺陷干预的影响

目的分析本院开展产前筛查、遗传咨询、超声产前检查等产前诊断后，活产婴儿中出生缺陷儿发生率下降情况。方法回顾本院大量开展产前筛查、遗传咨询、超声产前检查等产前诊断以后的活产婴儿中出生缺陷病例登记，采取χ^2检验统计、分析出生缺陷的发生率变化。结果2004年1月至2006年12月，在本院共计出生9339例围生儿，男性为4920例，女性为4416例，性别不明为3例；其中，出生缺陷儿为147例，出生缺陷的发生率为15．74‰（147／9339）。行产前诊断后，孕妇知情条件下选择终止妊娠（49例严重出生缺陷儿，经家属及孕妇本人要求，终止妊娠），使足月活产婴儿中的出生缺陷率下降为10．50‰（98／9339），与未开展前比较，差异有显著意义（χ^2=9．93，P〈0．001）。出生缺陷率下降情况分析显示，以神经管畸形降幅最大，先天性心脏病、唐氏综合征、总唇裂均有所下降。结论产前诊断可发现胎儿患有严重出生缺陷性疾病，为孕产妇提供终止病理妊娠的机会，是提高出生人口质量的重要措施之一。     

Vitamin A supplementation at birth delays pneumococcal colonization in South Indian infants

Nasopharyngeal colonization is a risk factor for pneumococcal disease, a leading cause of complications and death in infants. We assessed the impact of vitamin A supplementation in reducing pneumococcal colonization in infants from an area with endemic vitamin A deficiency. We recruited 464 2-mo-old infants from a rural area in South India. Infants were randomly assigned to receive two 7000-microg retinol equivalent doses of vitamin A (n = 239) or placebo (n = 225) orally at birth, and nasopharyngeal specimens were collected at ages 2, 4 and 6 mo. We studied the effect of vitamin A on culture-confirmed pneumococcal colonization and on the distribution of pneumococcal serotypes. Analyses were conducted by intention-to-treat. The risk of colonization among infants aged 4 mo who were not colonized by age 2 mo was significantly reduced in the vitamin A group compared with the placebo group [odds ratio 0.51 (0.28, 0.92), P = 0.02). The odds of colonization were 27% lower in the treatment group than in the placebo group [odds ratio 0.73 (0.48, 1.1), P = 0.13]. No differences were detected in the prevalence of invasive serotypes. The risk of colonization with penicillin-resistant isolates was 74% lower in the vitamin A group than in the placebo group at 2 mo of age. However, the prevalence of penicillin-resistant isolates was only 4%. Neonatal vitamin A supplementation may play a role in lowering morbidity rates associated with pneumococcal disease by delaying the age at which colonization occurs.